Cervical cancer education in schools can reach a significant number of adolescents. This systematic review and meta-analysis examined whether school-based education is effective for improving: i) knowledge and risk perception of cervical cancer/HPV infection; and ii) attitudes and intentions toward, and uptake of, HPV vaccination and cervical cancer screening among female students.
We searched six databases from inception to November 2020 and included English language papers describing RCTs of any form of cervical cancer education delivered to female students in a school setting. Standardized Mean Differences and Odds Ratios were calculated using random-effects models. Methodological quality of the included studies was assessed using the revised Cochrane risk of bias tool for randomized trials and the GRADE approach.
Thirteen studies were included in this review. School-based education improved students’ cervical cancer/HPV infection knowledge and intentions toward HPV vaccination but not their cervical cancer/HPV infection risk perception, attitudes or uptake of HPV vaccination. Face-to-face active learning approaches seemed beneficial in improving vaccination uptake. All the school-based education interventions were one-off education events focussed on HPV vaccination only. The quality of evidence was rated from low to moderate. Only one study was judged overall as having a low risk of bias.
More robust studies with well-conducted randomization, and better reporting of research in accordance with recommended guidelines are needed to provide high-quality evidence about the benefits of school-based education in improving cervical cancer prevention. Innovations in active learning approaches such as game-based learning, and reinforcement techniques should be considered.
Ama Ampofo, The University of Newcastle, Callaghan, Australia
Allison Boyes, The University of Newcastle, Callaghan, Australia
Phinda Khumalo, The University of Newcastle, Callaghan, Australia
Lisa Mackenzie, The University of Newcastle, Australia